A simple strategy to reduce pneumonia risk and improve patient outcomes

Hospital-acquired pneumonia (HAP) is a common infection associated with adverse outcomes, particularly in intensive care units (ICUs). Traditionally, chlorhexidine oral care has been used for prevention, but its effectiveness has been questioned.

A recent meta-analysis of 15 randomised trials explored the impact of daily toothbrushing as an alternative strategy for HAP prevention. The study included nearly 2,800 patients, with approximately 80% in ICUs. Intervention groups underwent toothbrushing and tongue brushing with chlorhexidine or plaque-removing toothpaste two to four times daily, while control groups received oral care with chlorhexidine swabbing (without toothbrushing) twice daily. The findings revealed that toothbrushing significantly lowered the risk of HAP by 33% and reduced the ICU death risk by 19%.

The benefits were particularly notable for patients receiving invasive mechanical ventilation. Moreover, toothbrushing was linked to fewer days of mechanical ventilation (reduced by 1.2 days) and a shorter ICU length of stay (reduced by 1.8 days). Notably, the positive effects of toothbrushing were consistent even with twice-daily brushing.

This study, published in the JAMA Internal Medicine, suggests that incorporating toothbrushing into ICU oral care routines could be a valuable strategy to prevent HAP and improve patient outcomes, offering a simpler and potentially more effective approach than previous practices.